Defining and Redefining Family Involvement in Practice: An Implementation Trial of a Locally Adaptable Patient-Centered Professional Development Tool in Two Ontario Intensive Care Units

Abstract

Research on best practices for family member involvement has shown that such involvement improves care quality in critical care settings and helps to reduce medical errors leading to adverse events. Although many critical care units promote the principle of “patient-centered care” and family member involvement, there can be a significant gap between knowledge about these processes and their translation into practice. This article is based on an implementation trial of a patient and family involvement knowledge-based tool that involves an educational component for frontline health care workers. By combining ethnographic observation, semistructured interviews, focus groups, and document analysis, we were able to not only examine health care provider views on family involvement but also explore the areas of tension that arose in practice because the introduction of the family involvement tool exposed local factors that shaped the conditions of possibility of family involvement. In particular, unspoken preferences, assumptions, and concerns about family involvement were brought to the fore because this intervention disrupted well-entrenched power dynamics related to family involvement and professional boundaries. Through this ethnographic research, we found that the concept of patient-centered care is not uncontroversial among health care providers and that the form of its practice was largely up for individual interpretation. Interventions and policies that aim to promote patient-centered and family-centered care would benefit from addressing the ways in which these ideas affect the work of different health care professionals and incorporating nursing concerns around family involvement.

Patient Involvement in CPD: Provocations and Possibilities

“…Using a Foucauldian discourse analysis of relevant texts in the domain of diabetes care, they convincingly argue that disagreements and incongruencies on the nature of PCC, how PCC works, and for whom PCC works is likely to cause additional complexities for patient engagement programs that treat PCC as a commonly understood rationale. Alexanian et al 10 follow a similar train of thought, engaging in an ethnographic study to explore rationales for family involvement in intensive care units. Through their exploration of unspoken preferences, assumptions, and concerns about family involvement, they demonstrate that aspirations for family involvement in intensive care units are not uncontroversial.…”

The 2021 Paul Mazmanian Journal of Continuing Education in the Health Professions Award for Excellence in Research

“…Previous authors have sensitized us to the role and value of family members or caregivers in the philosophy and practice of healthcare. 7–9 Here, the authors reveal a tension in this “ideal.” Specifically, they find that when pressed to engage family members or caregivers in the process of care, healthcare providers “maintained a provider-centric notion of family involvement wherein they defined, assessed, facilitated and limited family members' role.” 2 What these study findings suggest is an effort to understand social dynamics, beyond policy, and beyond educational interventions that limit or promote family involvement; in this case, the relationship among care providers, family members, or caregivers and their given context. The authors conclude by pointing our attention toward incorporating nursing concerns into interventions intended to support family involvement and that “a deeper understanding of this dynamic could then provide opportunities for tailored CPD for healthcare professionals.” What we take away is that the conditions in which family and caregiver involvement exist are not only clinical but personal, cultural, and historical social conditions as well.…”

“…1 The 2021 award has been given to Janet Alexanian, Ian Fraser, Orla Smith, and Simon Kitto for the study titled "Defining and Redefining Family Involvement in Practice: An Implementation Trial of a Locally Adaptable Patient-Centered Profession Development Tool in Two Ontario Intensive Care Units." 2 This paper will be free to access online for one year after the publication date of the award announcement. Because of the high standard of original research published in JCEHP during 2021, we felt obliged and excited to also share 2 additional honorable mentions.…”

Supporting Interprofessional Collaboration in Deprescribing: Needs Assessment for an Education Program

“…deprescribing process to build interprofessional communication that centralizes the patient and ensures practice consistency. 7 For the best uptake in interprofessional CPD, flexibility, convenience, and portability should be at the forefront during design and consider a range of situational factors linked to learner characteristics, pedagogical approaches, and external factors. 8 Educational needs assessments can provide important insights into facilitators and challenges faced by HCPs when engaging in CPD and provide an opportunity to better implement effective educational opportunities.…”

“…5 It also needs to highlight the intersection of professional cultures and practices across the deprescribing process to build interprofessional communication that centralizes the patient and ensures practice consistency. 7…”